Information Collection

Main Study - Number to Complete the Screener

IC 232989 under ICR 201809-0910-003 · OMB 0910-0864.

Documents and Forms

Document Name Document Type
Appendix A - Screener.docx Other-Screener
Appendix B - Recruitment.docx Recruitment Materials IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Main Study - Number to Complete the Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener			Appendix A - Screener.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,525	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,525	3,525
Annual IC Time Burden (Hours)	106	106
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Materials	Appendix B - Recruitment.docx	09/12/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.